Method and apparatus for lateral reduction and fusion of the spine

ABSTRACT

A method and device are provided for reducing abnormal vertebral orientation using a fixation plate that is used in conjunction with a positioning tool to reduce spinal deviation and properly position and secure adjacent vertebrae for fusion of the spine. The disclosed embodiments are particularly useful in minimally invasive surgical techniques such as laterally performed anterolisthesis and retrolisthesis.

BACKGROUND OF THE INVENTION

Fixation or fusion of individual vertebrae is frequently accomplishedusing rods and plates to secure bone grafts or implants between adjacentvertebral members. Conventional fusion techniques have failed in manyinstances to properly position the affected vertebrae for optimalfixation with respect to the graft.

SUMMARY OF THE INVENTION

An embodiment of the present invention may therefore comprise anapparatus for manipulating vertebral orientation and stabilizing spinalvertebrae comprising: a fixation plate having a central aperture and aplurality of first-end fastener holes and a plurality of second-endfastener holes positioned on opposing ends of the fixation plate; atleast one fixed fastener that secures a first vertebrae through thefirst-end fastener holes to fixate position and rotation of thefirst-end of the fixation plate with respect to the first vertebrae; anadjustable fastener that secures a second vertebrae through thesecond-end fastener holes to temporarily fixate position and allowrotation of the second-end of the fixation plate with respect to thesecond vertebrae; a positioning tool that is keyed to interface with theaperture of the fixation plate and engages the aperture to adjust theorientation of the first vertebrae relative to the second vertebrae bytransferring force from the positioning tool through the fixation plateto the first vertebrae and the second vertebrae; a stabilizer implantedbetween the first vertebrae and the second vertebrae through theaperture; the second-end fastener holes that facilitate repositioning ofthe adjustable fastener to vary the distance between the fixed fastenerand the adjustable fastener to compress the stabilizer between the firstvertebrae and the second vertebrae and rigidly secure position androtation of the adjustable fastener to the second vertebrae.

An embodiment of the present invention may therefore comprise a methodof manipulating vertebral orientation and stabilizing spinal vertebraecomprising: fixing position and rotation of a first-end of a fixationplate to a first vertebrae; temporarily fixing position and allowingrotation of a second-end of the fixation plate to a second vertebrae;engaging a central aperture on the fixation plate with a positioningtool that is keyed to interface with the central aperture; adjustingorientation of the first vertebrae with respect to the second vertebraeby transferring force from the positioning tool through the fixationplate to the first vertebrae and the second vertebrae; removing thepositioning tool from the fixation plate; implanting a stabilizerbetween the first vertebrae and the second vertebrae through theaperture; releasing the temporary fixation of the adjustable fastener;compressing the stabilizer between the first vertebrae and the secondvertebrae by adjusting a distance between the fixed fastener and theadjustable fastener; and, fixing the distance between first vertebraeand the second vertebrae by rigidly securing position and rotation ofthe adjustable fastener to the second vertebrae.

An embodiment of the present invention may also comprise device formanipulating vertebral orientation and stabilizing spinal vertebraecomprising: a fixation plate comprising plurality of first-end fastenerholes and a plurality of second-end fastener holes positioned onopposing ends of the fixation plate; at least one fixed fastener thatsecures a first vertebrae through the first-end fastener holes to fixposition and rotation of the first-end of the fixation plate withrespect to the first vertebrae; an adjustable fastener that secures asecond vertebrae through the second-end fastener holes to temporarilyfix position and allow rotation of the second-end of the fixation platewith respect to the second vertebrae, the second-end fastener holes thatfacilitate repositioning of the adjustable fastener to vary the distancebetween the fixed fastener and the adjustable fastener and rigidlysecure position and rotation of the adjustable fastener to the secondvertebrae; and, a central aperture for transferring force from apositioning tool through the fixation plate to the first vertebrae andthe second vertebrae, the central aperture that is of sufficient size toaccommodate insertion of a stabilizer between the first vertebrae andthe second vertebrae.

BRIEF DESCRIPTION OF THE DRAWINGS

In the drawings,

FIG. 1 is a lateral view of a section of spine experiencing abnormalvertebral orientation.

FIG. 2 is a lateral view of an embodiment of a fixation plate utilizedfor a lateral reduction and fusion of a section of a spine that isexperiencing anterolisthesis.

FIG. 3 is a perspective view of an embodiment of a fixation plate.

FIG. 4 is a perspective view of an embodiment of a positioning key formanipulation and positioning a fixation plate and affixed vertebrae.

FIG. 5 is a detailed perspective view of an embodiment of a positioningkey for manipulation and positioning a fixation plate and affixedvertebrae.

FIG. 6A is a lateral view of an embodiment of a fixation plate prior tobeing positioned using a positioning key to laterally reduceanterolisthesis of a section of a spine such as depicted in FIG. 2.

FIG. 6B is a lateral view of an embodiment of a fixation plate that hasbeen positioned using a positioning key to laterally reduceanterolisthesis of a section of a spine such as depicted in FIG. 2.

FIGS. 7 is a lateral section view of an embodiment of a fixation platethat has been secured to a vertebral wall with threaded fasteners.

FIGS. 8 is a superior transverse section view of an embodiment of afixation plate that has been positioned using a positioning key andsecured to a lateral vertebral wall utilizing threaded fasteners such asdepicted in FIG. 6.

FIGS. 9 is a lateral view of an embodiment of a fixation plate utilizedfor a lateral reduction and fusion of a section of a spine that isexperiencing retrolisthesis.

FIG. 10 is a lateral view of an embodiment of a fixation plate that hasbeen positioned using a positioning key to laterally reduceretrolisthesis of a section of a spine such as depicted in FIG. 9.

FIG. 11 is an anterior view of an embodiment of a fixation plateutilized for angular reduction and fusion of a section of a spine thatis experiencing lateral slip.

FIG. 12 is an anterior view of an embodiment of a fixation plate thathas been positioned using a positioning key to reduce lateral slip of asection of a spine such as depicted in FIG. 11.

FIG. 13 is a superior transverse section view of an embodiment of afixation plate that has been secured to an anterior vertebral wallutilizing threaded fasteners such as depicted in FIG. 12.

DETAILED DESCRIPTION OF THE INVENTION

While this invention is susceptible to embodiment in many differentforms, there is shown in the drawings and will be described herein indetail specific embodiments thereof with the understanding that thepresent disclosure is to be considered as an exemplification of theprinciples of the invention and is not to be limited to the specificembodiments described.

The disclosed embodiments provide a method and apparatus to reduceabnormal vertebral orientation using a fixation plate that is used inconjunction with a positioning tool to reduce the deviation and properlyposition and secure the adjacent vertebrae. These embodiments are usefulin minimally invasive surgical techniques such as reduction of laterallyperformed anterolisthesis and retrolisthesis.

FIG. 1 depicts a lateral view of a section of lumbar spine experiencingabnormal vertebral orientation 100. As seen in FIG. 1 vertebrae #2 104,and vertebrae #4 108, are properly aligned on the spinal axis 102.Vertebrae #3 106 is experiencing abnormal vertebral orientation in acondition known as anterolisthesis. As can be seen in this example,vertebrae #3 106 is aligned on a deviation axis 110 which does notcorrespond to the spinal axis 102. In a circumstance such as this,intervertebral discs can be ruptured, herniated, torn, degenerated orotherwise rendered insufficient to support the vertebral column andspacing necessary between each vertebrae to permit nerve passage andarticulation. Conditions like these can be caused by numerous factorssuch as trauma, disease, tumors, infections and other degenerativemaladies and are often treated by stabilizing the vertebra adjacent tothe affected intervertebral disc. This is often performed by fusingvertebra within the spine following vertebrectomy surgery or disectomy.When a disc (or portion thereof) is removed, a stabilizer such as agraft, mechanical implant or the like is introduced and placed incompression in the intervertebral space formerly occupied by the disc.Both the graft and vertebrae need to be positioned and stabilized sothat a proper fusion of the involved section of the spine can takeplace. The procedure may also be used to implant an artificial discwhere the fixation plate 112 is later removed to allow range of motionwithin the affected spine region.

FIG. 2 is a lateral view of an embodiment of a fixation plate utilizedfor a lateral reduction and fusion of a section the spine that isexperiencing anterolisthesis. As can be seen in FIG. 2, a fixation plate112 is positioned on the lateral aspect of the vertebral body ofabnormally displaced vertebrae #3 106, anterior of the pedicle. Assumingin this case that the disc between vertebrae #3 106 and vertebrae #4 108has already been removed by conventional means, proper alignment andspacing of these two adjacent discs is now performed. As illustrated,fixation plate 112 is positioned in general alignment with the deviationaxis 110 of vertebrae #3 106. One or two drill holes 124 are bored intothe vertebral body of vertebrae #3 106 corresponding to the position ofleft superior fastener hole 114 and/or right superior faster hole 116.Fasteners (detailed in later Figures) are then placed into the drillhole(s) and secured leaving a small gap between the head of the fastenerand the fixation plate 112 to allow for rotational movement of thedevice. Once vertebrae #3 106 has been slideably attached to thefixation plate 112, the proper distance between the adjacent vertebraecan be set by positioning an additional drill hole 124 on vertebrae #4108 corresponding with the right inferior fastener hole 120 of fixationplate 112. An additional fastener may then be placed into the drill hole124 through the multi-positional right inferior fastener hole 120 and asecured similar to the fasteners secured into vertebrae #3 106 allowingrotational movement of the device. No fastener is placed in the leftinferior fastener hole 118 at this time because the fixation plate 112is not ultimately positioned with respect to vertebrae #4 108.

As stated above, the distance between the adjacent vertebrae is set bythe relative position of the fixation plate 112 and the fastenerssecured to the vertebrae. This distance and the aforementionedpositioning is aided by incorporating a keyed aperture 122, through thefixation plate 112, allowing the surgeon visual and physical access tothe intervertebral space. This opening may additionally facilitate theinsertion or manipulation of the stabilizer (graft or implant) withinthe intervertebral space once the fixation plate 112 has been secured.

FIG. 3 is a perspective view of an embodiment of a fixation plate 112such as that which can be utilized for lateral reduction and fusion of asection of a spine as detailed in FIG. 2. The fixation plate 112 isadapted for securing the stabilizer within the spine and is preferablymade of a rigid biocompatible material such as titanium, stainless steelcarbon fiber or the like. The plate may incorporate vertical curvaturesas shown, which facilitate close contact with the vertebral body oneither lateral or anterior sides but may also incorporate horizontalcurvature (not shown) which may aid in maintaining anterior-posteriorcurvatures of the spine making the device applicable along the length ofthe spinal column including cervical, thoracic and lumbar regions.

As shown, the fixation plate 112 incorporates a series of fastener holesthat can be readily adapted for locating fasteners in a variety ofpositions. These fastener holes are located substantially in the cornersof the fixation plate 112 with each being depicted with multiplefixation points. With this particular embodiment, a fastener can beplaced in any one of the fixation points within the fastener hole andallow minor rotation of the plate while maintaining its position withrespect to the other fasteners. The variety of sizes, shapes andcurvatures may be utilized for the fixation plate 112 in order toaccommodate different size vertebrae and different applications andlevels of vertebrae. For example, cervical, thoracic and lumbar regionsmay each have individually sized plates for both lateral and anteriorplacement.

As described above, the keyed aperture 122 allows visual and physicalaccess to the intervertebral space and facilitates placement of thefixation plate 112 as well as providing access for insertion andmanipulation of the stabilizer (graft or implant). A second function ofthe keyed aperture 122 is to provide a contact point for a positioningtool that can be temporarily mated with fixation plate 112 to impartforce upon the plate and affixed vertebrae thereby positioning thevertebrae into proper alignment for fusion. The keyed aperture 122 iscreated of sufficient size to allow close visual inspection of theintervertebral space and the interface between a graft/implant. Theaperture may additionally aid in the ultimate determination of thefastener location. Whereas a rectangular or square shaped keyed aperture122 is depicted in FIG. 3, it falls within the scope of the describedembodiments to allow various shaped apertures such as hexagonal,octagonal, trapezoidal, rounded rectangle, oval or the like which allowmating with a positioning tool and access through the aperture for astabilizer.

FIG. 4 is a perspective view of an embodiment of a positioning key 200for manipulation and positioning a fixation plate and affixed vertebrae.As previously mentioned, fixation plate 112 is loosely secured to twoadjacent vertebrae that are in the process of being fused. A positioningkey 200 comprises a grip or handle 202 that is connected to a key 206 bya rigid or semi-rigid shaft 204 that allows the transmission oftranslational or rotational force from the handle 202 to the key 206.The key 206 may additionally have sight access 210 in the form of portsor holes that allow the user greater visual access of the tool and itsinterface with the fixation plate 112.

The key 206 inserts into keyed aperture 122 of the fixation plate 112 toa depth of approximately the thickness of the plate. The externalsurface of the key 206 mates with the internal surface of the keyedaperture 122 and a stop 208 prevents the key from being inserted toofar. Once inserted, the positioning key 200 can be rotated to impartrotational force on the fixation plate 112, and through the fasteners tothe adjacent vertebrae. Similarly translational force can be imparted inthe same manner giving the user mechanical advantage to easily andprecisely guide the vertebrae into alignment and proper position forfusion.

FIG. 5 is a detailed perspective view of an embodiment of a positioningkey 200 for manipulation and positioning a fixation plate and affixedvertebrae. As shown in FIG. 5, the key 206 is approximately cubical butcan be a variety of shapes which will allow it to impart force from thehandle 202 and shaft 204 to the fixation plate 112. The key depth 212,or the distance that the key 206 can be inserted into the plate, isregulated by a stop 208 that contacts the plate surface giving the userpositive tactile feedback that the key 206 is properly engaged.

FIGS. 6A and 6B are lateral views of an embodiment of a fixation plate112 being positioned using a positioning key 200 to laterally reduceanterolisthesis of a section of a spine such as depicted in FIG. 2. Oncethe fixation plate 112 has been secured to vertebrae #3 106, in themanner described in FIG. 2 using fixed fasteners 126, the key 206 of thepositioning key 200 is inserted into the key aperture 122 until the stop208 contacts the surface of the plate. Pressure may now be exerted bythe user to align vertebrae #3 106 and align vertebrae #4 108 for fusionusing the adjustable fastener 128 as a pivot for the rotation. In theparticular condition described in FIG. 2, a counter clockwise rotationof the handle will distract the disc space and reduce the vertebralbody. A stabilizer may now be placed in the intervertebral spaceutilizing the keyed aperture 122. Once the stabilizer (graft) is inplace, the tool is used to maintain the desired reduction. The clamp maythen be inserted into the protruding fastener heads between thevertebrae to compress the graft. With the vertebrae now aligned andpositioned, the left inferior fastener hole 118 is in proper positionwith respect to vertebrae #4 108, and drill hole 124 can be bored suchthat a fastener may be placed therein. At this point all fasteners maybe tightly secured forming fixed fasteners 126 providing a rigid,stable, precise, translated fixation between the adjacent vertebrae thatleaves access to the intervertebral space formed by a gap 129 containingthe stabilizer.

FIG. 7 is a lateral section view of an embodiment of a fixation plate112 that has been secured to a vertebral wall with threaded fasteners.As shown in FIG. 7, a fixation plate 112 is placed in contact with thevertebral body of vertebrae #4 108, such as was shown in FIG. 2. A drillhole 124 is bored into the bone tissue and a threaded fastener 128 isplaced through an adjustable fastener point 132 and screwed intoposition. The threaded fastener 128 shown in this example incorporates afastener shaft 134 that provides a smooth cylindrical surface and allowsrotation of the fixation plate about the adjustable fastener point 132when the fastener 128 is not fully tightened. The adjustable fastenerpoint 132 has multiple positions for which a fastener 128 may bepositioned thereby allowing greater flexibility in setting the distancebetween adjacent vertebrae. The adjustable fastener points 132 may alsobe an elongated groove or slot that also allows the flexible positioningof the fixation plate 112 prior to fully tightening fasteners 128.

The fasteners 128 are ultimately inserted into the bone to a sufficientdepth such that the fixation plate 112 cannot freely move with respectto the surface of the vertebrae, but may enable a small amount ofmovement under substantial force, thereby accommodating a small amountof natural shifting that occurs during the fusion between thestabilizer/graft and the adjacent vertebrae. The fasteners may alsoinclude a lock or locking mechanism such as a lock washer, lock plate,locking fastener head, ridged fastener holes, or the like to prevent anyreverse rotation or withdrawal from the bone and fixation plate.

Traditionally, approaches to spine surgery have necessitated prolongedrecovery time because a large incision was used to visualize theaffected disc. In order to perform this procedure, large sections of theback muscles are moved away from their spinal attachments. Thistraditional surgical approach (i.e., dissecting the muscles) producesthe majority of the perioperative pain and delays return to fullactivity and may necessitate the use of significant pain medication anddelays return to normal activity. Additionally, the dissection of theparaspinal muscles from their normal anatomic points of attachmentresults in scarring of these muscles. The various layers of theindividual muscle scar to one another thereby decrease their independentfunction. Furthermore, it has been found that this type of dissectionsometimes results in the loss of innervation (i.e., the supply of nervestimulation) of the muscles with subsequent wasting away resulting in apermanent weakness of the back muscles. By utilizing the aforementionedmethods and devices, the surgeon may perform lateral reduction andfusion procedure in a minimally invasive manner.

In conventional fusion surgery, the surgeon starts by correcting thespinal alignment with a contemporary correction instrument thattypically includes rods that are intended to be attached to thevertebrae. Once in place, these rods obstruct the fitting of plates usedto stabilize the spine. If the correction instrument is removed prior todefinitive fixation of the plate, it is necessary to make adjustments inthe plate alignment prior to ultimate fixation.

By attaching the fixation plate 112 to the vertebrae, and then adjustingthe vertebral orientation with the positioning key 200, no correctioninstrument rods are used and there is therefore, no interference betweenthe rods and the plate. This allows the surgeon to use lessinstrumentation, tools and hardware in the surgical procedure therebyreducing incision size and enabling access to the spine in a morelateral manner thereby avoiding the large muscle masses immediatelylateral and dorsal to the spine.

FIG. 8 is a superior transverse section view of an embodiment of afixation plate 112 that has been positioned using a positioning key 200and secured to a lateral vertebral wall utilizing threaded fastenerssuch as depicted in FIG. 6. As shown in FIG. 8, fixation plate 112 iscurved to match the surface of the lateral vertebral wall facilitatinggood contact between the plate and bone. Threaded fixed fasteners 126secure the fixation plate 112 and may be placed in a radial orientationwith respect to the spinal axis 102 of vertebra #3 106. The keyedaperture 122 maintains a transverse cut through the fixation plate 112in order to facilitate contact with the key 206 of the positioning key200. It is clear from FIG. 8 that a force created by twisting of thehandle of the positioning key 200 can be translated through the fixationplate 112 to the vertebra #3 106.

FIG. 9 is a lateral view of an embodiment of a fixation plate 112utilized for a lateral reduction and fusion of a section the spine thatis experiencing retrolisthesis. In a manner similar to that depicted inFIG. 2 a fixation plate 112 is positioned on the lateral aspect of thevertebral body of abnormally displaced vertebrae #3 106, anterior of thepedicle. Assuming also in this case that the disc between vertebrae #3106 and vertebrae #4 108 has already been removed by conventional means,proper alignment and spacing and of these two adjacent discs is nowperformed. As illustrated, fixation plate 112 is positioned in generalalignment with the deviation axis 110 of vertebrae #3 106. One or twodrill holes 124 are bored into the vertebral body of vertebrae #3 106corresponding to the position of left superior fastener hole 114 and/orright superior fastener hole 116.

Fasteners, such as those depicted in FIG. 7 are then placed into thedrill hole(s) and secured leaving a small gap between the head of thefastener and the fixation plate 112 to allow for rotational movement ofthe device. Once vertebrae #3 106 has been slideably attached to thefixation plate 112, the proper distance between the adjacent vertebraecan be set by positioning an additional drill hole 124 on vertebrae #4108 corresponding with the left inferior fastener hole 118 of fixationplate 112. An additional fastener may then be placed into the drill hole124 through the left inferior fastener hole 120 and secured similar tothe fasteners secured into vertebrae #3 106 allowing rotational movementof the device. No fastener is placed in the right inferior fastener hole120 at this time because the fixation plate 112 is not ultimatelypositioned with respect to vertebrae #4 108. As was performed in theexample of FIG. 2, the distance between the adjacent vertebrae is set bythe relative position of the fixation plate 112 and the fastenerssecured to the vertebrae.

FIG. 10 is a lateral view of an embodiment of a fixation plate 112 thathas been positioned using a positioning key 200 to laterally reduceretrolisthesis of a section of a spine such as depicted in FIG. 9. Oncethe fixation plate 112 has been secured to vertebrae #3 106, the key 206of the positioning key 200 is inserted into the key aperture 122 untilthe stop 208 contacts the surface of the plate. Pressure may now beexerted by the user to align vertebrae #3 106 and align vertebrae #4 108for fusion. In the particular condition described in FIG. 9, a clockwiserotation of the handle will distract the disc space and reduce thevertebral body. A stabilizer may now be placed in the intervertebralspace utilizing the keyed aperture 122. Once the graft is in place, thetool is used to maintain the desired reduction. The clamp may then beinserted into the protruding fastener heads between the vertebrae tocompress the graft. With the vertebrae now aligned and positioned, theright inferior fastener hole 120 is in proper position with respect tovertebrae #4 108 and drill hole 124 can be bored such that a fastenermay be placed therein. At this point all fasteners may be tightlysecured forming fixed fasteners 126 providing a rigid, stable, precise,translated fixation between the adjacent vertebrae that leaves access tothe intervertebral space formed by a gap 129 containing the graft.

FIG. 11 is an anterior view of an embodiment of a fixation plate 112utilized for angular reduction and fusion of a section the spine that isexperiencing lateral slip. In a manner similar to that depicted in FIG.2 a fixation plate 112 is positioned on the anterior aspect of thevertebral body of abnormally displaced vertebrae #3 106. Assuming alsoin this case, that the disc between vertebrae #3 106 and vertebrae #4108 has already been removed by conventional means, proper alignment andspacing of these two adjacent discs is now performed. In a mannersimilar to that detailed in FIGS. 2 and 9, fixation plate 112 ispositioned in general alignment with the deviation axis 110 of vertebrae#3 106. One or two drill holes 124 are bored into the vertebral body ofvertebrae #3 106 corresponding to the position of left superior fastenerhole 114 and/or right superior faster hole 116. Fasteners, such as thosedepicted in FIG. 7 are then placed into the drill hole(s) and securedleaving a small gap between the head of the fastener and the fixationplate 112 to allow for rotational movement of the device. Once vertebrae#3 106 has been slideably attached to the fixation plate 112, the properdistance between the adjacent vertebrae can be set by positioning anadditional drill hole 124 on vertebrae #4 108 corresponding with theleft inferior fastener hole 118 of fixation plate 112. An additionalfastener may then be placed into the drill hole 124 through the leftinferior fastener hole 120 and secured similar to the fasteners securedinto vertebrae #3 106 allowing rotational movement of the device. Nofastener is placed in the right inferior fastener hole 120 at this timebecause the fixation plate 112 is not ultimately positioned with respectto vertebrae #4 108. As was performed in the example of FIGS. 2 and 9,the distance between the adjacent vertebrae is set by the relativeposition of the fixation plate 112 and the fasteners secured to thevertebrae.

FIG. 12 is an anterior view of an embodiment of a fixation plate thathas been positioned using a positioning key to reduce lateral slip of asection of a spine such as depicted in FIG. 11. Once the fixation plate112 has been secured to vertebrae #3 106, the key 206 portion of thepositioning key 200 is inserted into the key aperture 122 until the stop208 contacts the surface of the plate. Pressure may now be exerted bythe user to align vertebrae #3 106 and align vertebrae #4 108 forfusion. In the particular condition described in FIG. 12, a clockwiserotation of the handle will distract the disc space and reduce thevertebral body. A graft or implant may now be placed in theintervertebral space utilizing the keyed aperture 122. Once the graft isin place, the tool is used to maintain the desired reduction. The clampmay then be inserted into the protruding fastener heads between thevertebrae to compress the graft. With the vertebrae now aligned andpositioned, the right inferior fastener hole 120 is in proper positionwith respect to vertebrae #4 108 and drill hole 124 can be bored suchthat a fastener may be placed therein. At this point all fasteners maybe tightly secured forming fixed fasteners 126 providing a rigid,stable, precise, translated fixation between the adjacent vertebrae thatleaves access to the intervertebral space containing the graft.

FIG. 13 is a superior transverse section view of an embodiment of afixation plate 112 that has been secured to an anterior vertebral wallutilizing threaded fasteners such as depicted in FIG. 12. As shown inFIG. 13, fixation plate 112 is curved to match the surface of theanterior vertebral wall facilitating good contact between the plate andbone. Threaded fixed fasteners 126 secure the fixation plate 112 and maybe placed in a radial orientation with respect to the spinal axis 102 ofvertebra #3 106. The keyed aperture 122 maintains a transverse cutthrough the fixation plate 112 in order to facilitate contact with thekey 206 of the positioning key 200.

The foregoing description of the invention has been presented forpurposes of illustration and description. It is not intended to beexhaustive or to limit the invention to the precise form disclosed, andother modifications and variations may be possible in light of the aboveteachings. The embodiment was chosen and described in order to bestexplain the principles of the invention and its practical application tothereby enable others skilled in the art to best utilize the inventionin various embodiments and various modifications as are suited to theparticular use contemplated. It is intended that the appended claims beconstrued to include other alternative embodiments of the inventionexcept insofar as limited by the prior art.

1. A system for manipulating vertebral orientation of and stabilizingadjacent spinal vertebrae comprising: a fixation plate having a centralaperture and a plurality of first-end fastener holes and a plurality ofsecond-end fastener holes positioned on opposing ends of said fixationplate; at least one fixed fastener that secures a first vertebraethrough said first-end fastener holes and fixate position and rotationof said first-end of said fixation plate with respect to said firstvertebrae; an adjustable fastener that secures a second vertebraethrough said second-end fastener holes to temporarily fixate positionand allows rotation of said second-end of said fixation plate withrespect to said second vertebrae; a positioning tool that is keyed tointerface with said aperture of said fixation plate and engages saidaperture to adjust the orientation of said first vertebrae relative tosaid second vertebrae by transferring force from said positioning toolthrough said fixation plate to said first vertebrae and said secondvertebrae; a stabilizer for implantation between said first vertebraeand said second vertebrae through said aperture; said second-endfastener holes that facilitate repositioning of said adjustable fastenerto vary the distance between said fixed fastener and said adjustablefastener to compress said stabilizer between said first vertebrae andsaid second vertebrae and rigidly secure position and rotation of saidadjustable fastener to said second vertebrae.
 2. The system of claim 1further comprising: said fixation plate that has a substantiallyrectangular shape.
 3. The system of claim 1 further comprising: saidfixation plate that has an arc shape to approximately match a vertebralbody curve of said first and second vertebrae.
 4. The system of claim 1further comprising: said central aperture that has a center point thatis substantially coincident with the spinal axis at a pointapproximately equidistant from said first and second vertebrae.
 5. Thesystem of claim 1 wherein said central aperture further comprises anopening of sufficient size to accommodate insertion of said stabilizer.6. The system of claim 1 wherein said plurality of first-end fastenerholes further comprises: a pair of circular holes.
 7. The system ofclaim 1 wherein said plurality of first-end fastener holes furthercomprises: a pair of longitudinally extending slots.
 8. The system ofclaim 1 wherein said plurality of second-end fastener holes are spacedsubstantially equidistant from the center of said fixation plate.
 9. Thesystem of claim 1 wherein said plurality of second-end fastener holesfurther comprises a pair of longitudinally extending slots.
 10. Thesystem of claim 1 wherein said second-end fastener holes accommodatemultiple fixation points for said adjustable fasteners comprise saidfixed fasteners.
 11. The system of claim 1 wherein said fixed fastenersare threaded fasteners.
 12. The system of claim 1 wherein saidadjustable fasteners are threaded fasteners that have not been tightenedinto said second vertebrae.
 13. The system of claim 1 furthercomprising: a lock that prevents withdrawal of said fixed fasteners fromsaid fixation plate.
 14. The system of claim 1 wherein said positioningtool further comprises: a shaft connecting a key for engaging andtransferring force from a handled grip to said aperture.
 15. The systemof claim 1 wherein said positioning tool further comprises: a sightaccess that allows visual inspection of said aperture through saidpositioning tool.
 16. The system of claim 1 wherein said stabilizer isselected from the group consisting of a bone graft, a spinal implant,and an artificial disc. 17-26. (canceled)
 27. A system for manipulatingvertebral orientation of and stabilizing adjacent spinal vertebraecomprising: means for fixing position and rotation of a first-end of afixation plate to a first vertebrae with a fixed fastener; means fortemporarily fixing position and allowing rotation of a second-end ofsaid fixation plate to a second vertebrae with an adjustable fastener;means for adjusting orientation of said first vertebrae with respect tosaid second vertebrae by engaging a central aperture on said fixationplate with a positioning tool that is keyed to interface with saidcentral aperture; means for compressing a stabilizer that is insertedbetween said first vertebrae and said second vertebrae through saidcentral aperture by adjusting a distance between said second-end of saidfixation plate; and, means for fixing said distance between said firstvertebrae and said second vertebrae by securing position and rotation ofsaid second-end of said fixation plate to said second vertebrae.